bi syndrome

[Guest guest]

Todd:

 

You raise excellent points. Probably 60% or more of my practice is tx of

neuromuscular issues. I have to say that my primary modalities are external TCM

techniques combined with neuromuscular therapy with some internal support using

CH. As you suggested I am ironically more familiar with and get better results

using CH for internal disorders. I would very much like to and feel that I NEED

to become much more adept at using CH for what I tx most often, muscular issues.

 

Frankly, I have not yet seen literature to support this quest. I would greatly

appreciate guidance in this direction.

 

Mark Fradkin

 

 

Wed, 18 Feb 2004 10:15:07 -0800

<

bi syndrome

 

I am curious how much instruction students and px received in the

herbal treatment of bi syndrome. We have a popular elective at PCOM,

but the subject is otherwise not well covered. Our OM classes cover bi

syndrome pattern differentiation, acupuncture selection and standard

textbook formulas. However the actual complexity of prescribing for bi

syndrome patients is left unaddressed (except in the elective I

mention). Also, how much instruction in external applications? I

received none and little is taught at PCOM. This would seem to be an

oversight that ignores an important fact. 60% of OM patients

nationwide come for neuromuscular problems, many of which are either

due to or complicated by painful obstruction. Due to necessity, I have

made an extensive study of this subject in english and find herbal

treatment to be very helpful in many cases. But not du huo ji sheng

tang for everyone.

 

Now this lack of training in this area raises a question for me. The

herbal community is very focused on internal medicine complaints rather

than musculoskeletal disorders. This dominates our discussion here,

workshop topics and educational agendas. Yet only 25% of patients

nationwide visit acupuncturists for internal disorders. And while many

of these patients have internal diseases, OM is not yet widely used for

these conditions. No more than 3% come for any single class of

internal disorders (respiratory in this case). I am currently reading

a translation of a chinese bi syndrome text by some french guy and the

emphasis in this text is decidedly upon herbology. It seems

counterproductive to devote so much time to the study of rarely treated

conditions and give short shrift to that seen most frequently. Since

any herbal specialty is an avenue to deep study of herbology in

general, why is there not more emphasis on pain treatment with herbs?

One would still have to understand formula construction and

modification. How to address complex conditions of hot, cold, vacuity,

repletion, etc. But one would have the added benefit of strong

familiarity with strategies focused specifically on pain treatment.

 

As everyone knows, I am a vocal advocate for integrating chinese

herbology into the mainstream care of a wide range of internal

disorders. That has been the driving force that led me to TCM and has

kept me here for so long. Most of you also know I consider myself

primarily a pragmatist and it is the utilitarian nature of CM that

mainly interests me. But how pragmatic is it to focus master's level

education on internal medicine rather than pain management. The survey

results of acupuncture usage I have been quoting recently were somewhat

of a wakeup call to me. If our services are mainly used for

neuromuscular problems (which includes autoimmune diseases in most

cases), perhaps our master's programs should really focus on making us

true specialists in this area. Now that we have accredited doc

programs, perhaps those are the place to specialize in various forms of

internal medicine. The dividing line between L.Ac. and DAOM may turn

out to be in who gets to treat internal complaints on a wide scale. I

already have inklings that the PCOM DAOM, with its emphasis on

integrative med, with MD's on the doc clinical staff, is creating a

context that is much more appealing to MD's vis a vis the use of CM for

chronic illness other than pain.

 

Neuromuscular complaints are hard enough to treat as it is. The

difficulty of any specialty is why WM and CM in china create

specialists, not generalists, for serious illnesses. It seems the

public has already decided what our specialty is. The title of L.Ac.

kind of pidgeonholes us as well. Primarily acus, thus primarily pain.

Well, why not go with the flow. If these are our patients, this what

we should be best at. Now I know SOME of you have practices of mostly

internal med patients or have great success getting your

musculoskeletal patients to commit to longterm treatment for

concomitant internal complaints, I think this is not the norm. Most

patients do not have the discipline or time or money to make these

commitments. We have a lot of education to do and perhaps only DAOM

status will pave the way after all (did I just write that??!!). In the

meantime, let's get best at what we do most. Fact is, whatever a few

very established folks on this list are doing, most current students

and new px and mostly doing neuromusc work. Am I right? I used to

bemoan this state of affairs till I realized that writing formulas for

bi syndrome and injury was just as fun as writing them for anything

else. When I was in private practice in OR, I limited my practice to

10 hours per week and only took internal med cases. But now at PCOM, I

treat or supervise 50 cases per week and luck of the draw makes most of

them neuromusc. If your sole income is to be from practice, don't fail

to deeply study pain management from both east and west.

 

 

 

Chinese Herbs

 

 

FAX: ups

[Guest guest]

Frankly, I have not yet seen literature to support this quest. I would greatly

appreciate guidance in this direction.

>>>Mark hopefully my next book will help

alon

 

 

[Guest guest]

, Mark Fradkin <mfradkin@c...>

wrote:

 

>

> Frankly, I have not yet seen literature to support this quest. I would

greatly

appreciate guidance in this direction.

>

 

 

Guillaume's Rheumatology (ISBN: 0-939616-26-2), a translation from the

french, is an interesting work. While the authors do not use a standardized

terminology, they are clearly careful translators and explain all their

interpretations in some detail. The book includes selected classical tracts on

acupuncture tx of bi and excerpted translation of a modern chinese manual on

bi (mostly herbal and familiar, but some gems here). Finally, the author's own

approach to treating various areas of the body. They are influenced by van

nghi's brand of vietnamese acupuncture, which relies heavily on rectifying qi

flow in the channels.